Health care bills are slowly making their way through both chambers of Congress. Last night the House passed a $1.1 trillion bill that would insure an additional 35 million Americans. Importantly, the bill makes it illegal for insurance companies to deny health insurance to those with pre-existing conditions, or to cancel your policy if you develop an expensive disease.

The House bill also calls for a ‘public option’, or government-sponsored health plan available for individual purchase. This isn’t thought likely to survive a Senate vote.

While I was being interviewed on XM Satellite’s Book Radio last week, a caller expressed dismay at the proposed level of government intervention in health care. I sympathized with his point of view. While writing House of Hope and Fear I learned that Seattle’s public hospital, Harborview, remained financially healthy in spite of very little government funding. How? Partly because the hospital needs to compete for business with every other hospital in town. Public hospitals operating primarily on the dole don’t do nearly as well.

But the free market isn’t a cure-all. Private sector success has increasingly come from excluding sick people from needed health care. Nearly one in six Americans is now inadequately insured, or not insured at all, and the problem is only growing worse. No doubt health care reform will be expensive. But doing nothing could cost even more. We pay for universal health care now, and in the priciest way possible — through our Emergency Rooms. This year’s health care bills won’t solve all of our problems, but they look to be a reasonable start.

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2 responses to “onwards”

The public option is not about hospitals being on the dole. What it does is make the insurance companies more competitive. What is competitive about a system that sets rates from prescription medicene, to what they will or will not pay for? If people want and can afford to pay to be in hospitals that are like hotels that is up to them. There is something wrong with a system that rewards people who find loopholes in insurance policys.

I read your second book and appreciate your heart and dedication, but there has to be a way to keep medical costs under control without equating the public option with poor medical care. You are too smart to espouse such drivel.

Hi Marty, thanks for your comment. Let me clarify: when I talk about public hospitals being on the dole, it’s not related to the public option, and it doesn’t necessarily refer to substandard care. Being on the dole means that public hospitals like Chicago’s Stroger (ie Cook County) are funded by local taxes, rather than by the medical care they provide. Thanks to the rapidly growing cost of care at Stroger, sales taxes in Cook County have quickly risen to become among the highest in the U.S. The situation is not dissimilar in other big cities.

Whether we like it or not, hospitals must find ways to remain finally solvent, or their out-of-control costs may cause them to close. Grady Hospital in Atlanta has struggled mightily with this in recent years.

A public option would be of great value to public hospitals and their uninsured patients.

audrey young

I'm a general internist from Seattle. My first book was What Patients Taught Me. The latest book is House of Hope and Fear, published in August 2009, and now out in paperback. For more about both books and about physician writers, please visit my website.